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Training in Psychodynamic Psychotherapy

To the Editor: We read with great interest the Clinical Case Conference by Kristin Kassaw, M.D., and Glen O. Gabbard, M.D. (1), and appreciate their emphasis on creating a psychodynamic formulation within the doctor-patient relationship. We strongly believe that the consideration of such a formulation should be paramount during residency training in psychiatry. From a literature review (2) it emerged that this kind of formulation can be used to better organize clinical data, induce empathy, design a treatment, and generate a hypothesis in the field of research. We believe that the 10 major reasons for creating a psychodynamic formulation that were underlined by the task forces of the Association for Academic Psychiatry and the American Association of Directors of Psychiatry Residency training (3) should always be reviewed during residency training in psychiatry.

We owe Drs. Gabbard and Kassaw a great deal for their efforts in teaching how to improve the doctor-patient relationship in the fields of psychiatry and psychotherapy. It should not be forgotten that beginning therapists can improve their psychotherapeutic skills; this process is actually facilitated in the psychodynamic psychotherapy practice (4). Psychodynamic psychotherapy, no doubt, allows the development of the particular skills involved in the doctor-patient relationship; thus, psychiatrists may be able to understand inner conflicts, fears, and anxiety (5). During psychiatric training, it is crucial to develop empathic skills and a deep emotional awareness, as facing psychic sorrow moves one toward experiencing specific projective and identification anxieties. The acquisition of these professional skills must be also considered a valid and fundamental therapeutic element. Nevertheless, the psychodynamic psychotherapy model has still to deal with empirical validation, its legitimacy in the academic environment, and more widespread use in clinical practice.

References

1. Kassaw K, Gabbard GO: Creating a psychodynamic formulation from a clinical evaluation. Am J Psychiatry 2002; 159:721-726[Free Full Text]
2. Friedman RS, Lister P: The current status of psychodynamic formulation. Psychiatry 1987; 50:126-141[Medline]
3. Mohl PC, Lomax J, Tasman A, Chan C, Sledge W, Summergrad P, Notman M: Psychotherapy training for the psychiatrist of the future. Am J Psychiatry 1990; 147:7-13[Abstract/Free Full Text]
4. Buckley P, Conte HR, Plutchik R, Karasu TB, Wild KV: Learning dynamic psychotherapy: a longitudinal study. Am J Psychiatry 1982; 139:1607-1610[Abstract/Free Full Text]
5. Tatarelli R, Comparelli A, Pompili M: Psychodynamic psychotherapy during residency training in psychiatry. Medic 2002; 10:39-44

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